P0343 / #1255: ASSOCIATION BETWEEN PROLONGED CARDIOPULMONARY BYPASS AND AORTIC CROSS CLAMP TIME WITH EXTRACARDIAC OUTCOMES AFTER PEDIATRIC CARDIAC SURGERY.

Cardiac surgery employing cardiopulmonary bypass exposes infants to a high risk of morbidity and mortality. The objective of this study was to assess the utility of clinical and laboratory variables to predict the development of low cardiac output syndrome, a frequent complication following cardiac surgery in infants. We performed a prospective observational study in the pediatric cardiovascular ICU in an academic children’s hospital. Thirty-one patients with congenital heart disease were included. Serum levels of nucleosomes and a panel of 20 cytokines were measured at six time points in the perioperative period. Cardiopulmonary bypass patients were characterized by increased levels of interleukin-10, -6, and -1α upon admission to the ICU compared to non-bypass cardiac patients. Patients developing low cardiac output syndrome endured longer aortic cross-clamp time and required greater inotropic support at 12 h postoperatively compared to bypass patients not developing the condition. Higher preoperative interleukin-10 levels and 24 h postoperative interleukin-8 levels were associated with low cardiac output syndrome. Receiver operating characteristic curve analysis demonstrated a moderate capability of aortic cross-clamp duration to predict low cardiac output syndrome but not IL-8. In conclusion, low cardiac output syndrome was best predicted in our patient population by the surgical metric of aortic cross-clamp duration.

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Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia in adult and paediatric cardiac surgery: a systematic review and meta-analysis

Perfusion ◽

10.1177/0267659120919350 ◽

2020 ◽

Vol 35 (8) ◽

pp. 724-735 ◽

Cited By ~ 3

Author(s):

Ashlynn Ler ◽

Faizus Sazzad ◽

Geok Seen Ong ◽

Theo Kofidis

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Relative Risk ◽

Confidence Interval ◽

Mean Difference ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cardiopulmonary Bypass Time ◽

Paediatric Cardiac Surgery ◽

Adult Cardiac Surgery

Background: In recent years, the use of del Nido cardioplegia, initially intended for paediatric cardiac surgery, has been extended to adult cardiac surgery in many institutions. Our aim was thus to compare the outcomes of the use of del Nido cardioplegia with that of conventional cardioplegia and discuss its role in both adult and paediatric cardiac surgery. Method: A systematic literature search was conducted in August 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any retrospective studies and randomised controlled trials that reported findings comparing the outcomes of the use of del Nido cardioplegia with that of St. Thomas cardioplegia were included. Results: We observed shorter aortic cross-clamp time (mean difference: −15.18, confidence interval: −27.21 to −3.15, p = 0.01) and cardiopulmonary bypass time (mean difference: −13.52, confidence interval: −20.64 to −6.39, p = 0.0002) associated with the use of del Nido cardioplegia in adult cardiac surgery as compared to St. Thomas cardioplegia. Defibrillation rates were significantly lower in patients who had been given del Nido cardioplegia, in both adult (relative risk: 0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p = 0.02). Conclusion: Del Nido cardioplegia may be a viable alternative to the use of St. Thomas cardioplegia in both adult and paediatric patients, providing similar postoperative outcomes while also affording the additional advantage of shorter aortic cross-clamp time and cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates of defibrillation (in both adult and paediatric cardiac surgery).

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Risk and Consequences of Postoperative Delirium in Cardiac Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1708046 ◽

2020 ◽

Vol 68 (05) ◽

pp. 417-424

Author(s):

Yukiharu Sugimura ◽

Nihat Firat Sipahi ◽

Arash Mehdiani ◽

Georgi Petrov ◽

Mareike Awe ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Postoperative Delirium ◽

Heart Surgery ◽

Open Heart Surgery ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cross Clamp Time ◽

Preventative Strategy ◽

Potential Risk Factors

Abstract Background Delirium is a common complication after cardiac surgery that leads to increased costs and worse outcomes. This retrospective study evaluated the potential risk factors and postoperative impact of delirium on cardiac surgery patients. Methods One thousand two hundred six patients who underwent open-heart surgery within a single year were included. Uni- and multivariate analyses of a variety of pre, intra-, and postoperative parameters were performed according to differences between the delirium (D) and nondelirium (ND) groups. Results The incidence of delirium was 11.6% (n = 140). The onset of delirium occurred at 3.35 ± 4.05 postoperative days with a duration of 5.97 ± 5.36 days. There were two important risk factors for postoperative delirium: higher age (D vs. ND, 73.1 ± 9.04 years vs. 69.0 ± 11.1 years, p < 0.001) and longer aortic cross-clamp time (D vs. ND, 69.8 ± 49.9 minutes vs. 61.6 ± 53.8 minutes, p < 0.05). We found that delirious patients developed significantly more frequent postoperative complications, such as myocardial infarction (MI) (D vs. ND, 1.43% [n = 3] vs. 0.28% [n = 2], p = 0.05), cerebrovascular accident (D vs. ND, 10.7% [n = 15] vs. 3.75% [n = 40], p < 0.001), respiratory complications (D vs. ND, 16.4% [n = 23] vs. 5.72% [n = 61], p < 0.001), and infections (D vs. ND, 36.4% [n = 51] vs. 16.0% [n = 170], p < 0.001). The hospital stay was longer in cases of postoperative delirium (D vs. ND, 23.2 ± 13.6 days vs. 17.4 ± 12.8 days, p < 0.001), and fewer patients were discharged home (D vs. ND, 56.0% [n = 65] vs. 66.8% [n = 571], p < 0.001). Conclusions Because the propensity for delirium-related complications is high after cardiac surgery, a practical, preventative strategy should be developed for patients with perioperative risk factors, including higher age and a longer cross-clamp time.

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Totally endoscopic resection of atrial myxoma: early results of 26 patients in E hospital

Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam ◽

10.47972/vjcts.v33i.562 ◽

2021 ◽

Vol 33 ◽

pp. 38-43

Author(s):

Nguyen Hoang Nam ◽

Nguyen Cong Huu ◽

Tran Thuy Nguyen ◽

Hoang Van Trung ◽

Do Duc Thinh ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Endoscopic Surgery ◽

Atrial Myxoma ◽

Thoracic Wall ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cardiopulmonary Bypass Time ◽

Cross Clamp Time ◽

Early Results ◽

Postoperative Time

Objective: Myxoma is the most common form of non-malignant tumor that arises from connective tissue. Totally endoscopic surgery without robotic assistance can resect the entire atrial myxoma. This study aim to evaluate the early results of this surgical method. Methods: From January 2019 to April 2021, 26 patients (20 females, 6 males, mean age 49.5 ± 14.3) were diagnosed with atrial myxoma. All tumors of those patients were resected by totally endoscopic surgery. We evaluated the early outcome of this method based on the following criteria: mortality rates, conversion to open surgery, cardiopulmonary bypass time, aortic cross-clamp time, postoperative time. Results: Totally endoscopic surgery to resect atrial myxoma was successfully performed in all patients with surgical ports on the thoracic wall. The largest incision was not more than 1.5 cm in diameter. Mean cardiopulmonary bypass time was 134 ± 39 minutes, aortic cross-clamp time was 81.4 ± 26.4 minutes, mechanical ventilation time was 10.5 ± 4.6 hours, ICU length of stay was 2.1 ± 0.9 days, postoperative time was 6.9 ± 5.4 days. We had one case in which the excision of myxoma was performed contemporaneously with mitral valve annuloplasty. Conclusions: Initial outcomes of totally endoscopic surgery to resect atrial myxomas were satisfactory. However, to fully evaluate the effectiveness of this method, we need to conduct a long-term follow-up of these patients.

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Systematic Review and Meta-Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

Pediatric Anesthesia ◽

10.1111/pan.12560 ◽

2014 ◽

Vol 25 (2) ◽

pp. 135-142 ◽

Cited By ~ 13

Author(s):

Yaoyao Xiong ◽

Yanhua Sun ◽

Bingyang Ji ◽

Jinping Liu ◽

Guyan Wang ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Meta Analysis ◽

Pediatric Cardiac Surgery

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Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002805 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sheila J. Hanson ◽

Oliver Karam ◽

Rebecca Birch ◽

Ruchika Goel ◽

Ravi M. Patel ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pediatric Cardiac Surgery

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The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

Critical Care of Children with Heart Disease ◽

10.1007/978-3-030-21870-6_10 ◽

2020 ◽

pp. 113-129 ◽

Cited By ~ 4

Author(s):

Ana Maria Manrique ◽

Diana P. Vargas ◽

David Palmer ◽

Kent Kelly ◽

Steven E. Litchenstein

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pediatric Cardiac Surgery

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Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Perfusion ◽

10.1177/0267659120915387 ◽

2020 ◽

Vol 35 (8) ◽

pp. 826-832

Author(s):

Tomomi Hasegawa ◽

Yoshihiro Oshima ◽

Shinji Yokoyama ◽

Asuka Akimoto ◽

Yusuke Misaka ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Pilot Study ◽

Interleukin 6 ◽

Patient Characteristics ◽

Serum Levels ◽

Pediatric Cardiac Surgery ◽

Interleukin 8 ◽

Control Group ◽

Platelet Counts

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

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